Most emergency visits by children occur at nonpediatric emergency departments, which have more frequent antibiotic prescribing, according to a study published online Jan. 8 in Pediatrics.

Nicole M. Poole, M.D., M.P.H., from the University of Washington in Seattle, and colleagues used 2009 to 2014 National Hospital Ambulatory Medical Care Survey emergency department data to conduct a retrospective study involving patients aged 0 to 17 years discharged from emergency departments in the United States. The authors estimated the proportion of emergency department visits resulting in antibiotic prescriptions, stratified by antibiotic spectrum, class, diagnosis, and emergency department type.

The researchers found that 14 percent of the 29 million mean annual emergency department visits by children in 2009 to 2014 occurred at pediatric emergency departments. Compared with pediatric emergency departments, antibiotics were prescribed more frequently in nonpediatric emergency departments (24 versus 20 percent). Over time, antibiotic prescribing frequencies were stable. Forty-four percent of all antibiotics prescribed were broad spectrum and 32 percent were generally not indicated. Nonpediatric emergency departments had a higher frequency of prescribing macrolides compared with pediatric emergency departments (18 versus 8 percent); they also had lower frequency of first-line, guideline-concordant prescribing for the respiratory conditions studied (77 versus 87 percent).

"Pediatric antibiotic stewardship efforts in nonpediatric emergency departments have the potential to eliminate >2 million unnecessary antibiotic prescriptions annually and increase the rates of guideline-concordant antibiotic use among children seen in this setting," the authors write.

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